Individual
KIRK THIEMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
115 E 16TH ST, IDAHO FALLS, ID 83404-5919
(208) 523-6727
Mailing address
115 E 16TH ST, IDAHO FALLS, ID 83404-5919
(208) 523-6727
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5980
ID
Other
Enumeration date
09/19/2015
Last updated
09/19/2015
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